Population Studies Research Articles

Efficacy of surgical treatments for the management of solitary rectal ulcer syndrome: a network meta-analysis.

Solitary rectal ulcer syndrome (SRUS) is a benign and poorly understood disorder with complex management. Typical symptoms include straining during defaecation, rectal bleeding, tenesmus, mucoid secretion, anal pain and a sense of incomplete evacuation. Diagnosis is based on characteristic clinical symptoms and endoscopic/histological findings. Several treatments have been reported in the literature with variable ulcer healing rates. This study aimed to evaluate the efficacy of different treatments for SRUS. A systematic review and network meta-analysis were performed according to the PRISMA guidelines. Studies in English, French and Spanish languages were included. Papers written in other languages were excluded. Other exclusion criteria were reviews, case reports or clinical series enrolling less than five patients, study duplications, no clinical data of interest and no article available. A systematic literature search was conducted from January 2000 to March 2024 using the following databases: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus. The biases of the studies were assessed using the Newcastle-Ottawa scale or the Jadad scale when appropriate. Types of treatment and their efficacy for the cure of SRUS were collected and critically assessed. The study's primary outcome was to estimate the rate of patients with ulcer healing. A total of 22 studies with 911 patients (men 361, women 550) diagnosed with SRUS were analysed in the final meta-analysis. The pooled effect estimates of treatment efficacy revealed that surgery showed the highest ulcer healing rate (70.5%; 95% CI 0.57-0.83). Surgery was superior in the cure of ulcers with respect to medical therapies and biofeedback (OR 0.09 and OR 0.14). Solitary rectal ulcer syndrome is a challenging clinical entity to manage. Proficient results have been reported with the surgical approach, suggesting its positive role in cases refractory to medical and biofeedback therapy. Further studies in homogeneous populations are required to evaluate the efficacy of surgery in this setting. (PROSPERO registration number CRD42022331422).

O-043 Con

Abstract Dual and/or double trigger improve IVF success - CON The improvement of in vitro fertilization (IVF) outcomes remains a pivotal area of reproductive medicine research, with the dual trigger approach emerging as a significant innovation. This con abstract explores the scientific basis, methodology, and outcomes associated with the dual trigger strategy, juxtaposed with conventional triggering methods in IVF protocols. The dual trigger, incorporating both Gonadotropin-Releasing Hormone Agonist (GnRHa) and Human Chorionic Gonadotropin (hCG), has been posited to improve oocyte maturation, retrieval-, and live birth rates. By scrutinizing recent studies, clinical trials, and meta-analyses, this debate aims to delineate the efficacy, safety, and application scope of this approach. Initial investigations into the dual trigger method have highlighted its potential to ameliorate oocyte quality and maturity, which are crucial determinants of IVF success. The mechanism underlying this improvement involves the simultaneous activation of LH (Luteinizing Hormone) and FSH (Follicle Stimulating Hormone) receptors, enhancing follicular response and oocyte developmental competence. Studies have demonstrated an increase in the number of mature oocytes retrieved, attributed to the more synchronized and comprehensive follicular stimulation afforded by the dual trigger. This augmentation in oocyte quality and quantity directly correlates with enhanced embryo development profiles, and higher implantation and clinical pregnancy rates. Furthermore, the dual trigger method has shown promise in reducing the incidence of Ovarian Hyperstimulation Syndrome (OHSS), a severe complication of IVF treatments. By leveraging the luteolytic effects of GnRHa, this strategy minimizes the risk associated with exogenous hCG administration, thus offering a safer alternative for patients predisposed to OHSS. The application of the dual trigger in specific patient cohorts, such as those with PCOS or poor ovarian responders, has been underlined, indicating its potential for personalized reproductive medicine. However, the implementation of the dual trigger strategy is not without challenges. Variability in patient response necessitates a highly individualized approach, with precise dosing and timing adjustments to optimize outcomes. The existing literature presents a heterogeneity in study designs, populations, and outcome measures, which complicates the direct comparison of dual trigger efficacy against traditional methods. Furthermore, the long-term safety and potential impacts on offspring warrant further investigation, given the recent adoption of this approach. In conclusion, the dual trigger strategy may offer significant benefits in enhancing IVF outcomes. Its potential to improve oocyte maturity and quality could increase the number of retrievable oocytes and reduce the incidence of OHSS. However, it is important to acknowledge that, while the GnRH agonist trigger combined with a freeze-all strategy eliminates the risk of OHSS in women with PCOS, the dual trigger approach followed by fresh embryo transfer does not. Further research is imperative to refine its application, understand its mechanisms fully, and establish comprehensive guidelines for its use. The promise of the dual trigger approach underscores the importance of continuous innovation and evidence-based practices in enhancing the efficacy and safety of IVF treatments.

O-184 Piezo-ICSI reduces oocyte degeneration, improves ICSI success rates and has shown less dependence on the experience level of embryologists: cumulative data with 65,033 MII oocytes

Abstract Study question Dose piezo-ICSI improve the overall success rates of in ICSI operations compared with the conventional ICSI by the operators with different level of experience? Summary answer Piezo-ICSI showed lower oocyte degeneration rate during or after ICSI operations compared to the conventional ICSI for embryologists with different level of experience. What is known already Intracytoplasmic sperm injection (ICSI) with a glass micropipette can sometimes result in degeneration of the injected oocyte. Piezo-assisted ICSI has been developed as an alternative method to prevent such degeneration occurring during the procedure. It employs gentler and controlled impacts generated from the piezo electric elements attached to the injection micropipette holder to penetrate oolemma, and it does not require reciprocal aspiration of ooplasm required in the conventional ICSI. While there have been numerous study reports demonstrating the improvements in fertilization rates with piezo-ICSI, most of these studies have the limitation in the size study of population. Study design, size, duration We conducted a retrospective analysis of the ICSI results with 65,033 MII oocytes in 15,687 treatment cycles carried out between January 2018 and February 2023. ICSI were performed using the piezo-assisted equipment with flat-tip micropipettes (PIEZO PMM4G, Prime Tech Ltd., [n = 51,484, Piezo-group]) or in the conventional ICSI method with spiked-tip micropipettes (n = 13,549, C-group). Participants/materials, setting, methods Following the insemination with ICSI, the oocyte degeneration rate, fertilization rate per MII oocytes and blastocyst formation rate per 2PN embryos were evaluated in both the Piezo- and C-groups (n = 51,484 and n = 13,549, respectively). We also evaluated the degeneration rates and fertilization rates of ICSI by the operators: i.e., well-experienced embryologists (at least 10 years of experience) and less experienced embryologists (5 years or less of experience). Main results and the role of chance The fertilization and blastocyst formation rates in the Piezo-group were 83.8% (43,140/51,484) and 54.0% (23,300/43,140), respectively, which were significantly higher than the C-group (74.8% [10,132/13,549] and 36.6% [3,674/10,132], respectively, p < 0.01). The oocyte degeneration rate in the Piezo-group was 2.9% (1,493/51,484), which was significantly lower than the C-group (6.9% [933/13,549], p < 0.05). For the patients over 40 years old, the degeneration rate was also significantly lower in the Piezo-group (3.0% [632/20,770]) than the C-group (7.1% [351/4927], p < 0.01), while the fertilization and blastocyst formation rates were higher in the Piezo-group (82.6% [17,164/20,770] and 46.6% [7,997/17,164], respectively) than the C-group (72.8% [3,588/4,927] and 25.8% [926/3,588], respectively, p < 0.01). We found a marked drop in the oocytes degeneration rates in the Piezo group recorded from both well-experienced and less experienced embryologists. The degeneration rates recorded by less experienced embryologists were 2.8% (119/4,242) in Piezo-group and 8.6% (8/93) in the C group (p < 0.01), while the records by well-experienced embryologists were 2.7% (815/29,681) in the Piezo-group and 6.9% (555/8,037) in the C-group, respectively (p < 0.01). The fertilization rates of the Piezo-group by less experienced and well-experienced embryologists were 84.1%(3,569/4,242) and 83.4% (24,757/29,681), respectively, which were significantly higher the C-group (71.0％ [66/93] and 76.7％ [6,167/8,037], respectively, p < 0.01). Limitations, reasons for caution It is a retrospective study, in which the ICSI operations with piezo and the conventional methods were not equally assigned to the embryologists, especially, for those less experienced, thereby the number of conventional ICSI operations was more skewed to well-experienced embryologists than the less experienced colleagues. Wider implications of the findings Our results with piezo-ICSI showed a marked drop in the oocyte degeneration while achieving comparable fertilization rates amongst operators with different levels of experience. We found these as major advantages over the conventional method in standardizing the ICSI operation by filling the gap between embryologists with different length of carrier. Trial registration number Not applicable

P-159 Single-cell high-throughput methylation and transcriptomic analysis indicates variations in sensitivity to Folate-mediated one-carbon metabolism in mouse preimplantation embryos

Abstract Study question Do Folate-mediated one-carbon metabolism (FOCM) supplements impose methylating conditions that influence methylation and transcriptomic profiles during preimplantation period of mouse embryos? Summary answer Subtle differences in embryo methylation profiles were induced by FOCM supplements, despite transcriptomic signatures remained stable and selective genes related to metabolism were activated. What is known already Previous human studies of populations affected by seasonal variations in diet including folate availability have shown methylation changes in specific loci known as metastable epialleles (MEs). MEs exhibit stability across tissues, indicating these could be potential biosensors for heightened sensitivity to external methylating influences in early embryonic stages. Despite significant progress in IVF embryo culture conditions, the sensitivity to the outer metabolic environment during the extensive genomic transformation of embryo reprogramming remains inadequately understood. Study design, size, duration This is a prospective experimental study conducted from January 2023 to December 2023. A total of 111 fresh mouse zygotes (F1 hybrid (B6/CBA)) were subjected embryo culture conditions with different FOCM supplies of 5-MTHF and betaine up to expanded blastocyst stage (105 hours). At different timepoints, individual embryos were collected and disaggregated in individual cells for downstream single-cell analysis. Participants/materials, setting, methods Mouse zygotes were collected from the oviduct, washed and culture in KSOM supplemented with 5-MTHF and betaine at respectively concentrations of 50μM and 50μg/mL (THF/bet(50)), 10μM and 10μg/mL (THF/bet(10)) and no supplement till blastocyst stage at 37 °C, 6%CO2 and 5%O2. Individual embryos were collected at 2 cells, 4 cells, 8 cells, Morula and Blastocyst stage and disaggregated into single cells for subsequent single-cell RNAseq (SmartSeq2) and single-cell methylome analysis through Splinted Ligation Adapter Tagging (scSPLAT). Main results and the role of chance The methylation analysis conducted though scSPLAT revealed a comprehensive reduction in global methylation levels throughout developmental stages. Notably, zygotes exhibited a maximal proportion of methylated cytosines at CpG sites, while blastocysts displayed minimal methylation levels, with sporadic increases in isolated cells. Quantitative profiling indicated lower methylation intensities in treated embryos from zygote to 4 cells, followed by a reversal trend from 8 cells to blastocyst, suggestive of an enhanced assimilation of one-carbon metabolism (FOCM) supplements. Transcriptomic profiles obtained through scRNAseq exhibited correlation with developmental trajectories from zygote to blastocyst. However, no discernible variations were attributed to the combined exposure of Betaine and 5-MTHF. Gene enrichment analysis of differentially expressed genes at various timepoints highlighted specific metabolic responses, including mitochondrial oxidative stress and variations in glutathione metabolism. This suggests that the folate forms utilized in this study may possess a protective role as antioxidants, contributing to the observed effects on gene expression during embryonic development. Limitations, reasons for caution The methylation analysis shown in this study was a pilot carried out with low coverage of sequencing deepness, further analysis are ongoing to increase reads coverage. Wider implications of the findings Exposure of mouse embryos to FOCM enhanced global methylation during cell division from 8 cells to blastocyst, indicating heightened assimilation during DNA synthesis. While the transcriptomic signature remained stable, increased expression of genes linked to mitochondrial oxidative stress and glutathione metabolism suggests FOCM’s potential antioxidant role. Trial registration number not applicable

Conclusions regarding the role of expectations in placebo analgesia studies may depend on how we investigate it: A meta-analysis, systematic review, and proposal for methodological discussions.

Expectations are highlighted as a key component in placebo effects. However, there are different approaches to whether and how placebo studies should account for expectations, and the direct contribution has yet to be estimated in meta-analyses. Using different methodological approaches, this meta-analysis and systematic review examines the extent to which expectations contribute to pain in placebo studies. The databases PubMed, PsycINFO, Embase, and Web of Science were searched for placebo analgesia mechanism studies with numerical measures of both expectations and pain. Thirty-one studies, comprising 34 independent study populations (1566 individuals, patients and healthy participants) were included. Two meta-analyses were conducted: Meta-analysis 1, using study-level data, estimated the effect of expectation interventions without taking measures of expectations into account (expectations assumed). Meta-analysis 2, using individual-level data, estimated the direct impact of participants' expectations on pain (expectations assessed). Risk of bias was assessed using the Cochrane Risk-of-bias tool. Meta-analysis 1 showed a moderate effect of expectation interventions over no expectation intervention on pain intensity (Hedges g = 0.45, I2 = 54.19). Based on 10 studies providing individual-level data, meta-analysis 2 showed that expectations predicted pain intensity in placebo and control groups (b = 0.36, SE = 0.05), although inconsistently across study methodologies. Participants' expectations contributed moderately to pain in placebo analgesia studies. However, this may largely be influenced by how we measure expectations and how their contribution is conceptualized and analyzed - both within and across studies.

P-364 Impact on fertility outcomes in survivors after hematopoietic stem cell transplantation for benign and malignant hematologic disorders: a systematic review and meta-analysis

Abstract Study question What is the prevalence of infertility after hematopoietic stem cell transplantation (HSCT) in females and males up to the age of 1 year? Summary answer The overall prevalence of infertility (95% CI) in women treated with HSTC is 64% (0.58-0.70) and in men 39% (0.31-0.47). What is known already HSCT is a well-established treatment that has significantly increased survival in haematological malignancies and also benign diseases since its introduction in the 1980s. The use of high-dose chemotherapy and radiotherapy, myeloablative conditioning, combined with HSCT exposes serious long-term complications, including gonadal dysfunction and infertility. The risk of ovarian and testicular damage seems to be very high. Therefore, the European Society for Blood and Marrow Transplantation (EBMT) had recommended in 2015 to consider fertility preservation measures in children and adolescents requiring HSCT. However, the data on which this recommendation was based was limited and heterogeneous. Study design, size, duration The systematic review and meta-analysis is part of the FertiTOX project (www.fertitox.com) which aims to close the gap of data regarding gonadotoxicity of cancer therapies to enable more accurate counselling regarding fertility preservation. A systematic literature search was conducted in Medline, Embase and Cochrane in November 2023, considering papers published since 2000. Participants/materials, setting, methods A total of 1632 records were identified for abstract screening. Only females and males without recurrent disease and follow up of more than one year were considered. For the systematic review, 68 studies fulfilled the criteria. For the meta-analysis, studies with < 10 patients were excluded. Infertility was defined in females as very low AMH, hypergonadotropic hypogonadism, amenorrhoea and/or need for hormone replacement therapy and in males as low inhibin B and/or azoospermia. Main results and the role of chance In total, 68 out of 1632 studies were included in the final analysis. Malignant diseases were mainly acute myeloid / lymphoblastic leukemia, chronic myeloid leukemia/ lymphocytic leukemia and non-hodgkin’s and hodgkin’s lymphoma. Benign diseases were sickle cell disease, Fanconi anaemia, and β-thalassemia major. In the meta-analysis, 56 studies were included, comprising 1853 female malignant cases, 241 female benign cases, 1871 male malignant cases, and 226 male benign cases. The analysis, employing a random-effects model for estimating prevalence and its 95% confidence interval, revealed that the overall pooled prevalence of infertility exceeded 30% in all groups. The prevalence of infertility was highest in female malignant cases (65%, 95% CI: 0.58-0.71). In women with benign diseases it was 61% (95% CI: 0.48-0.73). In males with malignant diseases it reached 41% (95% CI: 0.32 to 0.51) and with benign diseases 31% (95% CI: 0.19 to 0.46). Heterogeneity of data was high as shown by female as shown by the malignant cases of 83% and benign cases of 65% in women and the malignant cases of 91% and benign cases of 74% in males. Limitations, reasons for caution The heterogeneity of the included studies due to treatment variations and diverse characteristics of the study populations with large age ranges, did not allow further subgroup analyses. Thus, an individual and reliable fertility prognosis is still difficult to give. Wider implications of the findings The results of this meta-analysis support the clinical necessity of fertility preservation counselling in females and males undergoing HSCT treatment. Further prospective studies addressing the individual impact of the HSCT treatment on gonadal function are needed Trial registration number The study protocol was registered at the international Prospective Register of Systematic Reviews, PROSPERO (Registry number CRD42023486928).

P-295 Impact of septate uteri on pregnancy and neonatal outcomes of IVF/ICSI–frozen embryo transfer

Abstract Study question What is the impact of septate uteri on reproductive and neonatal outcomes of IVF/ICSI–frozen embryotransfer? Summary answer septate uteri are associated with lower birthweight and worse fertility outcomes including lower Intrauterine implantation rate and lower live birth rates. What is known already Several studies have investigated the negative effects of septate uteri on pregnancy outcomes.However, an all-round and definitive conclusion has not been reached yet owing to the relatively low incidence of the disease and theheterogeneity of study populations, especially among women undergoing ART. Study design, size, duration This was a retrospective cohort study including 149 women with septate uteri and 13921 women with a normal uterus who underwent first frozen-thawed embryo transfer cycles of IVF/ICSI from january 2016 to December 2022. We compared reproductive outcomes. Participants/materials, setting, methods Reproductive outcomes of women with septate uteri were studied through propensity score-matched comparisons (patients with septate uterus respectively along with corresponding control group without uterine malformations). We also comparedpregnancy and neonatal outcomes. Main results and the role of chance Compared to the matched control group, women with septate uterus had asignificantly lower LBR(37.58% versus 50.56%, odds ratio (OR) 1.698 [95% CI: 1.161, 2.484], P = 0.006) and Intrauterine implantation rate(36.31% versus 45.67%, odds ratio (OR) 1.474 [95% CI: 1.06, 2.06], P = 0.021) Limitations, reasons for caution This was a single-centre, retrospective study in which neonatal data were extracted fromparental questionnaires. In patientswith uterine malformations, the number of babies with birth defects and twin pregnancies was relatively small, limiting the power of thestudy. Wider implications of the findings Compared to patients with a normal uterus, women with septate uterus have poorer reproductive outcomes. Pregnant women with a septate uterus need to be managed as high-risk pregnancies and followed withappropriate obstetric review. Trial registration number not applicable

P-742 In-vitro fertilization outcomes after laparoscopic repair of cesarean scar defect

Abstract Study question Does laparoscopic repair of cesarean scar defect improve in-vitro fertilization (IVF) outcomes? Summary answer Laparoscopic (LSC) repair of cesarean scar defect (CSD) should selectively indicated to patients experiencing repetitive pregnancy failure or having an increased depth of niche What is known already Cesarean section (CS) rate has markedly from 7% in 1990 to an estimated 29% of all births by 2030. CSD, also known as isthmocele or uterine niche, has emerged as a cause of secondary infertility, frequently encountered with recurrent implantation failures and cycle cancellations because of the endometrial fluid collection both in endometrium and uterine lower segment of cesarean scar. Study design, size, duration This is a retrospective study encompassing total of 62 patients. With 50 patients undergoing expectant management, 12 undergoing LSC repair of CSD at a single IVF center from 2019 to 2023. Primary outcomes included the clinical pregnancy rate and time to pregnancy, while secondary outcomes were the depth of CSD and residual myometrial thickness. Of the 72 patients, 68 patients underwent frozen embryo transfer. Participants/materials, setting, methods Patients with secondary infertility who had experienced more than two instances of implantation failure or cycle cancellation due to endometrial fluid collection were included. Laparoscopic repair of CSD was performed by a single gynecologic oncologist in accordance with the physician’s preference and patient consent. For patients in expectant management, diagnostic hysteroscopy and endometrial fluid suction were conducted prior to embryo transfer. Main results and the role of chance The age, BMI, gravidity, parity, or the number of previous cesarean section showed no statistical differences between the expectant management and the LSC repair group. The uterine position, either anteflexion was similar across groups. (all p value >0.05). Both the clinical pregnancy rate and live birth rate did not significantly differ between the expectant management group and the LSC repair group (26.0% vs 50.0%, p = 0.149, and 32.0% vs 60.0%, p = 0.149, respectively). The mean time to pregnancy was 7.38 months in the expectant management group and 9.80 months in LSC repair group, showed no significant difference (p = 0.240). Correlation analysis revealed a significantly moderate correlation between the initial depth of CSD and the depth of CSD at embryo transfer with clinical pregnancy (r = -0.424, P = 0.001). Furthermore, our data indicated that the CSD depth at embryo transfer was significantly impacted on clinical pregnancy outcomes from the multivariate regression logistic analysis (OR = 0.522, 95% CI [0.332 – 0.823]). Limitations, reasons for caution This study is retrospectively designed and including small sample size, caution is required in interpreting the findings. Wider implications of the findings This study suggests that the depth of niche influences clinical pregnancy outcomes. Laparoscopic repair may offer a viable treatment option who have experienced multiple failed cycles and increased depth of niche. Future studies with larger population studies may further indicate the LSC repair based on the depth of CSD. Trial registration number not applicable

P-378 Relation between AMH serum levels and recovered mature oocytes in infertile, healthy, and oncological patients

Abstract Study question Does AMH serum levels correlate with the recovered mature oocytes in similar way among infertile, healthy, and oncological patients? Summary answer AMH serum levels correlated well with the number of mature oocytes in infertile, healthy, and oncological patients What is known already AMH is a protein produced by granulosa cells from pre-antral follicles and uses as biomarker of ovarian reserve. The aim of ovarian stimulation in the IVF setting or fertility preservation is obtaining metaphase II oocytes. The value of serum AMH to predict the number of mature oocytes has not been study in a comparative way among infertile patients vs. healthy and oncological population Study design, size, duration Retrospective study of the AMH serum levels and number of recovered mature oocytes in oocyte vitrification cycles from April 2017 to June 2023. We included 78 patients with cancer, 119 healthy patients and 668 infertile patients undergoing oocyte vitrification for fertility preservation or as accumulation of oocytes strategy Participants/materials, setting, methods This single centre study included Infertile patients ≤ 42 with gynaecological pathology (endometriosis, polycystic ovarian syndrome, low ovarian reserve, and/or tubal factor), any type of cancer and healthy women demanding social fertility preservation. We excluded IVF healthy patients (normal patients with exclusively male factor). AMH serum level was measured before ovarian stimulation. We analysed the probability of obtain ≥ 8 mature oocytes considering as normal AMH (1.2 ng/mL). Ethical approval was obtained for this stud Main results and the role of chance IVF patients were older and had higher body mass index than the other two groups. AMH serum level (ng/mL) was similar among groups; in IVF patients (1.88 [1.67-2.09]); oncological patients (2.25 [1.85-2.65]), and healthy women (2.5 [2.2-2.8]). (p= 0.064). Ovarian stimulation was longer and more FSH units were employed in IVF patients. Oestradiol level at the oocyte maturation triggering was lower in oncological patients. The number of MII oocytes was significantly lower in IVF patients (6.1 [5.9-6.4]) compared with oncological and healthy patients (9.2[8.0-10.5]; 9.9 [9.0-10.8], respectively). AMH level correlated well with the number of recovered mature oocytes and similar among groups. The Odds Ratio to recover ≥ 8 mature oocytes considering as normal AMH (1.2 ng/mL) showed a probability 8.3 times higher in healthy patients, but only 0.3 times in IVF patients and 0.5 times in oncological patients. A OR: 9.1 was observed for obtain ≥ 8 mature oocytes between normal vs low AMH. The area under the curve in the ROC curve for AMH was 0.7191 Limitations, reasons for caution This study had limitations in the sample size and differences in ovarian stimulation protocol as oncological patients in hormone-dependent cancer received letrozole while conventional ovarian stimulation with FSH was performed in IVF and healthy patients. IVF patients’ group was heterogeneous in the aetiology of infertility Wider implications of the findings This study remarks the use of AMH in different conditions: infertility, oncological, and healthy status. Although no differences were found in correlation with the number of mature oocytes, the probability to obtain ≥ 8 mature oocytes with normal AMH was higher in healthy women compared with infertile patients Trial registration number 2306-VGO-128-EM

Phylogenomic analysis and dynamic evolution of chloroplast genomes of Clematis nannophylla

Clematis nannophylla is a perennial shrub of Clematis with ecological, ornamental, and medicinal value, distributed in the arid and semi-arid areas of northwest China. This study successfully determined the chloroplast (cp) genome of C. nannophylla, reconstructing a phylogenetic tree of Clematis. This cp genome is 159,801 bp in length and has a typical tetrad structure, including a large single-copy, a small single-copy, and a pair of reverse repeats (IRa and IRb). It contains 133 unique genes, including 89 protein-coding, 36 tRNA, and 8 rRNA genes. Additionally, 66 simple repeat sequences, 50 dispersed repeats, and 24 tandem repeats were found; many of the dispersed and tandem repeats were between 20–30 bp and 10–20 bp, respectively, and the abundant repeats were located in the large single copy region. The cp genome was relatively conserved, especially in the IR region, where no inversion or rearrangement was observed, further revealing that the coding regions were more conserved than the noncoding regions. Phylogenetic analysis showed that C. nannophylla is more closely related to C. fruticosa and C. songorica. Our analysis provides reference data for molecular marker development, phylogenetic analysis, population studies, and cp genome processes to better utilise C. nannophylla.

Validation of two automatic sphygmomanometers according to the modified International Standardization Organization 81060-2:2018 protocol in adults with a mid-upper arm circumference of 22 centimeters or less.

A recent International Organization for Standardization (ISO) Task Group report calls for research to investingate potential special populations in validation studies of automated blood pressure (BP) devices. Accordingly, we aimed to determine the accuracy of two previously validated BP monitors passed in a general population when measured in adults with a mid-upper arm circumference (MUAC) ≤ 22 cm. Test device A was the OMRON HEM 7121 equipped with the HEM CS24 cuff designed for an arm circumference of 17-22 cm. Test device B was the YuWell YE660Е with the YuWell '360°' cuff (18-36 cm). Data from 37 participants aged 20.14 ± 2.23 (18-28) years were analyzed according to criterion 1 of ISO Standard 81060-2 : 2018. According to criterion 1, the mean ± SD of the BP differences for the device A was -7.81 ± 5.20/-10.66 ± 5.48 mmHg (systolic/diastolic) and for the device B was -8.00 ± 6.30/-16.11 ± 5.15 mmHg (systolic/diastolic), respectively. This means that neither device met the requirements. Since devices A and B, which had passed in a general population study, failed in adults aged 18-28 years with an MUAC ≤ 22 cm, such individuals might be considered as new special population for validation studies.

Estimating regional and national cancer incidence in Uganda: a retrospective population-based study, 2013–2017

BackgroundCancer is becoming a major health problem in Uganda. Cancer control requires accurate estimates of the cancer burden for planning and monitoring of the cancer control strategies. However, cancer estimates and trends for Uganda are mainly based on one population-based cancer registry (PBCR), located in Kampala, the capital city, due to a lack of PBCRs in other regions. This study aimed at estimating cancer incidence among the geographical regions and providing national estimates of cancer incidence in Uganda.MethodsA retrospective study, using a catchment population approach, was conducted from June 2019 to February 2020. The study registered all newly diagnosed cancer cases, in the period of 2013 to 2017, among three geographical regions: Central, Western and Eastern regions. Utilizing regions as strata, stratified random sampling was used to select the study populations. Cases were coded according to the International Classification of Diseases for Oncology (ICD-0-03). Data was analysed using CanReg5 and Microsoft Excel.Results11598 cases (5157 males and 6441 females) were recorded. The overall national age-standardized incidence rates (ASIR) were 82.9 and 87.4 per 100,000 people in males and females respectively. The regional ASIRs were: 125.4 per 100,000 in males and 134.6 per 100,000 in females in central region; 58.2 per 100,000 in males and 56.5 per 100,000 in females in Western region; and 46.5 per 100,000 in males and 53.7 per 100,000 in females in Eastern region. Overall, the most common cancers in males over the study period were cancers of the prostate, oesophagus, Kaposi’s sarcoma, stomach and liver. In females, the most frequent cancers were: cervix, breast, oesophagus, Kaposi’s sarcoma and stomach.ConclusionThe overall cancer incidence rates from this study are different from the documented national estimates for Uganda. This emphasises the need to enhance the current methodologies for describing the country’s cancer burden. Studies like this one are critical in enhancing the cancer surveillance system by estimating regional and national cancer incidence and allowing for the planning and monitoring of evidence-based cancer control strategies at all levels.

Historical evolution of sex and age estimation techniques through the skull

The estimation of sex and age through cranial measurements is a fundamental practice in various fields such as physical anthropology, archaeology, and forensic medicine. Over the centuries, techniques and methodologies have been developed and refined to increase the accuracy of these estimates, reflecting advances in anatomical knowledge, imaging technology, and statistical analysis. This article aims to explore the historical evolution of these techniques, highlighting the major changes and innovations from the rudimentary methods used in early anthropological investigations to the sophisticated contemporary approaches incorporating cutting-edge technologies like computed tomography and machine learning algorithms. In addition to reviewing traditional methods, this study examines how the application of new technologies has contributed to greater accuracy and reliability in sex and age estimations, as well as the implications of these improvements for population studies and forensic investigations. By tracing this evolution, it seeks not only to provide a comprehensive overview of the historical development of these techniques but also to contextualize future trends and the challenges that still need to be addressed.

U shape association between triglyceride glucose index and congestive heart failure in patients with diabetes and prediabetes

BackgroundWhile previous population studies have shown that higher triglyceride-glucose (TyG) index values are associated with an increased risk of congestive heart failure (CHF), the relationship between TyG and CHF in patients with abnormal glucose metabolism remains understudied. This study aimed to evaluate the association between TyG and CHF in individuals with diabetes and prediabetes.MethodsThe study population was derived from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. The exposure variable, TyG, was calculated based on triglyceride and fasting blood glucose levels, while the outcome of interest was CHF. A multivariate logistic regression analysis was employed to assess the association between TyG and CHF.ResultsA total of 13,644 patients with diabetes and prediabetes were included in this study. The results from the fitting curve analysis demonstrated a non-linear U-shaped correlation between TyG and CHF. Additionally, linear logistic regression analysis showed that each additional unit of TyG was associated with a non-significant odds ratio (OR) of 1.03 (95%CI: 0.88–1.22, P = 0.697) for the prevalence of CHF. A two-piecewise logistic regression model was used to calculate the threshold effect of the TyG. The log likelihood ratio test (p < 0.05) indicated that the two-piecewise logistic regression model was superior to the single-line logistic regression model. The TyG tangent point was observed at 8.60, and on the left side of this point, there existed a negative correlation between TyG and CHF (OR: 0.54, 95%CI: 0.36–0.81). Conversely, on the right side of the inflection point, a significant 28% increase in the prevalence of CHF was observed per unit increment in TyG (OR: 1.28, 95%CI: 1.04–1.56).ConclusionsThe findings from this study suggest a U-shaped correlation between TyG and CHF, indicating that both elevated and reduced levels of TyG are associated with an increased prevalence of CHF.

Characteristics and completeness of reporting of systematic reviews of prevalence studies in adult populations: a meta-research study.

ObjectiveThe Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, first published in 2009, has been widely endorsed and compliance is high in systematic reviews of intervention studies. Systematic reviews of prevalence studies are increasing in frequency, but their characteristics and reporting quality have not been examined in large studies. Our objectives were to describe the characteristics of systematic reviews of prevalence studies in adults, evaluate the completeness of reporting and explore study-level characteristics associated with the completeness of reporting. Study design and settingWe did a meta-research study. We searched 5 databases from January 2010 to December 2020 to identify systematic reviews of prevalence studies in adult populations. We used the PRISMA 2009 checklist to assess completeness of reporting and recorded additional characteristics. We conducted a descriptive analysis of review characteristics and linear regression to assess the relationship between compliance with PRISMA and publication characteristics. ResultsWe included 1172 systematic reviews of prevalence studies. The number of reviews increased from 25 in 2010 to 273 in 2020. The median PRISMA score for systematic reviews without meta-analysis was 17.5 out of a maximum of 23 and, for systematic reviews with meta-analysis, 22 out of a maximum of 25. Completeness of reporting, particularly for key items in the methods section was suboptimal. Systematic reviews that included a meta-analysis or reported using a reporting or conduct guideline were the factors most strongly associated with increased compliance with PRISMA 2009. ConclusionReporting of systematic reviews of prevalence was adequate for many PRISMA items. Nonetheless, this study highlights aspects for which special attention is needed. Development of a specific tool to assess the risk of bias in prevalence studies and an extension to the PRISMA statement could improve the conduct and reporting of systematic reviews of prevalence studies.

Malignant Transformation of Benign Meningiomas with or without Radiotherapy

Most meningiomas are benign, slow growing tumors, which rarely progress to a higher grade. The incidence rate of malignant progression is estimated to be 2.98/1000 patient-year. However, non-skull base location is a significant risk factor for progression. The median time to malignant progression is 4.3 years; however, the cumulative rate of progression approaches a plateau after 10 years. Although radiosurgery does not appear to increase the incidence rate(0.5/1000 patient-year), exact comparisons have been difficult because of differences in study populations. The median time to progression is 7.0 years from initial diagnosis and 5.0 years from radiosurgery. The cumulative rate appears to increase even after 10 years. The risk of malignant transformation after radiotherapy may increase in patients with tumor-prone syndromes, with some controversies regarding patients with neurofibromatosis type 2. Although short term follow-up in patients with meningioma suggests that radiosurgery is safe, there is uncertainty regarding its use in pediatric patients, and those with tumor-prone syndromes.

Antimicrobial Sensitivity of Pseudomonas aeruginosa to Aztreonam, Amoxicillin, Erythromycin, Carbenicillin, Norfloxacin, Chloramphenicol, Gentamycin and Azithromycin after Exposure to Radiation Emitted from Radioactive Sources, Lasers and Exposure to Magn

Objective: The aim of this study to assess the sensitivity of P. aeruginosa for ATM, AML, E, CAR, NOR, CL, CN and AZM after exposure to radiation emitted from radioactive sources, Lasers and exposure to magnetized water. Study design: Cross-sectional in descriptive study design with case–control in analytical study design Backgrounds: P. aeruginosa gram negative bacteria occasion distinct kinds of contagion including epidermis, optics, ears, respiratory tract, urinary tract, intestines derived sepsis, soft tissues, skeleton and joint contagion. Radiation including ionizing and non-ionization depending on the energy of the radiated particles emitted Alpha, Beta and Gamma rays from different radioactive sources. Methodology: Study populations and bacterial deposition and identification of P. aeruginosa. Exposure P. aeruginosa to radiation at different times and doses. Antimicrobial susceptibility test for ATM, AML, E, CAR, NOR, CL, CN and AZM after exposure to radiation emitted from radioactive sources, Lasers and magnetized water. Results: After exposing P. aeruginosa to the Na23, CO60, Cs137 and Sr90 radioactive source without or without aluminum for (1,2,3) hr., the bacteria were examined for antibiotics and the results are high sensitivity to NOR, ATM, CAR. As well as, exposure to Nd: YAG laser in (10, 20) min. with exposure to magnetized water which show high sensitive to NOR and ATM antibiotics. Conclusions: The radioactive sources, Nd: YAG laser and magnetic water have a strong effect on bacteria and their sensitivity to antibiotics, so that their sensitivity rate increased very significantly compared to before exposure. The most effective antibiotics in killing bacteria after exposure are Aztreonam, Norfloxacin, Carbenicillin and Gentamycin (ATM, NOR, CAR and CN).

Global stability and modeling with a non-singular kernel for fractional order heroin epidemic model: Insights from different population studies

There has been a worldwide epidemic of heroin that has affected people, families, societies, and cultures across the world. Now, the heroin epidemic has transitioned from heroin abuse to the overuse of synthetic narcotics, which are widely accessible and inexpensively produced. In this work, a novel mathematical approach is applied to investigate the dynamics of the heroin epidemic model and its harmful effect on society with different population data. A heroin model has been constructed with the importance of a non-singular kernel in the sense of a generalized Mittag-Leffler kernel. The well-possedness of the proposed model is proven via fixed-point theory. To examine the heroin model, two equilibrium states have been determined. These equilibrium states are proven to be locally and globally asymptotically stable. To analyze the behavior of heroin, a basic reproduction number and sensitivity analysis are used to determine the impact of different parameters mathematically as well as through simulations. To find the approximate solution, we implement the Toufik-Atangana numerical method at different fractional order values. The sensitivity of the heroin model is carried out, and 3-D graphs show the significance of the parameter involved in the model. Finally, the numerical outcomes are presented with different values of fractional parameters.

Global stability and modeling with a non-singular kernel for fractional order heroin epidemic model: Insights from different population studies

There has been a worldwide epidemic of heroin that has affected people, families, societies, and cultures across the world. Now, the heroin epidemic has transitioned from heroin abuse to the overuse of synthetic narcotics, which are widely accessible and inexpensively produced. In this work, a novel mathematical approach is applied to investigate the dynamics of the heroin epidemic model and its harmful effect on society with different population data. A heroin model has been constructed with the importance of a non-singular kernel in the sense of a generalized Mittag-Leffler kernel. The well-possedness of the proposed model is proven via fixed-point theory. To examine the heroin model, two equilibrium states have been determined. These equilibrium states are proven to be locally and globally asymptotically stable. To analyze the behavior of heroin, a basic reproduction number and sensitivity analysis are used to determine the impact of different parameters mathematically as well as through simulations. To find the approximate solution, we implement the Toufik-Atangana numerical method at different fractional order values. The sensitivity of the heroin model is carried out, and 3-D graphs show the significance of the parameter involved in the model. Finally, the numerical outcomes are presented with different values of fractional parameters.

Disability and long-term breathlessness: a cross-sectional, population study

IntroductionDisability, resulting from altered interactions between individuals and their environment, is a worldwide issue causing inequities and suffering. Many diseases associated with breathlessness cause disability but the relationship between disability...